Peripheral Arterial Disease in Non-Diabetic Patients is Associated with Worse Outcomes after LVAD Implantation

Abstract

<h3>Purpose</h3> We sought to explore the short- and long-term outcomes of patients with severe PAD undergoing MCS. <h3>Methods</h3> We queried INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) database to identify patients undergoing LVAD implantation between June 2006 and December 2017. We then identified patients with PAD, defined in the database as co-morbidity and/or concern for patient treatment or contraindication for transplant. We further subdivided this cohort by presence of severe diabetes. <h3>Results</h3> We identified 15,162 patients who underwent LVAD implantation during the study period, out of which, 699 patients had severe PAD. Compared to patients without PVD, patients with PAD were older, greater proportion of male, more likely to have ischemic etiology. History of severe DM, stroke, pulmonary disease, and chronic kidney disease, and current smoking were reported more frequently in patients with PAD. Median follow-up duration was 12.8 months (IQR 5.2-25.8). Kaplan Meier analysis demonstrated that presence of PAD was associated with substantial increase in mortality (41.9% vs 27.5%, p<0.001) (Figure A). Furthermore, after adjusting for other significant predictors, PAD was independently associated with increased mortality following LVAD implantation (HR 1.18, 95% CI 1.04-1.33, p=0.009) in multivariable analysis. In the analysis stratified by the presence or absence of severe diabetes, patients with PAD in the non-diabetic strata were identified to have an increased early and late mortality (Figure B) whereas no association between PAD and early or late mortality was identified in diabetic patients (Figure C). <h3>Conclusion</h3> Severe PAD is associated with a substantially increased in early and late mortality after LVAD implantation. Further studies are needed to better ascertain the cause of mortality in this patient cohort.